Calcium Channel Blockers in Heart Failure

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2 了 1 年 48 露說 2007/02/24 06:59 PM

3 聯路易 22 年聯

4 年 / 連不兩都年塞年令不不年 38 不料年冷烈累不塞了兩裡了 2 43 老年數都年 2 不了精不塞度 6 神都年不良力不離 1 2

5 不更 :2008/05/10 17:00 行不不不年了量

7 不? 狀年女

8 Case 1 46-year-old man was admitted because of sudden onset of severe chest pain with cold sweating for 30min. No any risk factors except smoking one pack per week, and quit since 6 mon ago Troponin I 0.05 ng/ml CK 113 U/L CK-MB 3.3 U/L

No any risk factors except smoking one pack per week, and

9 Mr. Wang, 46-year-old man, History No: , initial ECG at admission

10 CAG-case 1, before PCI

11 CAG-case 1, after PCI

12 Question of case 1 來不? 不?

14 狀兩狀

15 狀狀降狀狀

16 狀狀狀塞塞

17 塞

18 狀 38% 不不

19 狀塞切狀

20 : ( 年 ) ( ) 糖尿 ( 女 ) 力 ( ) 老年尿

21 年塞 : 40 2

22 : > 90 (35 ) 女 > 80(31 )

23 64 切 256 切

25 1. 不 (Unstable Angina, UA) 2. ST 塞 (STEMI) 3. ST 塞 (NSTEMI) 狀 : : 狀不裂, 不 STEMI NSTEMI

26 JACC 2000;36:970

27 不塞不裂塞

28 ? 狀 : CPK, CPK-MB, Troponin

29 臨狀惡

30 勒 3-15

32 烈

33 0 < h 塞

34 Unstable angina Non STE MI Onset < 20min STEMI Acute injury 30min 不塞塞

35 塞

36 塞

37 降塞

38 塞不塞

39 AMI EKG AMI 不? ACS :

40 Reperfusion, Rescue PCI, Facilitated PCI, Late PCI Hours to days Weeks to years Lancet 2008, Aug 16;372:572

41 療 MONA Therapy Oxygen at 4L/min, Use N.C. or mask NTG 0.6 mg, If SBP> 90 mmhg Morphine IV, 1-3mg q5min Aspirin 160 mg to 325 mg

42 ACS 療 ST ACS 療律不 / : Beta-blocker, ICD 復 : ASA, Heparin, Clopidogrel, 復 ( ): ACEI/ARB, Beta-blocker / : statins 塞 : tpa 療 : NTG

43 ACS 療 ST ACS: 律不 / : Beta-blocker, ICD 復 : ASA, Heparin, Clopidogrel, 復 ( ): ACEI/ARB, Beta-blocker / : statins 塞 : tpa 療 : NTG 不 tpa Glycoprotein IIb/IIIa inhibitors: IV

44 Unstable angina Non STE MI Onset < 20min STEMI Acute injury 30min 不塞塞

45 流療 for STEMI 1. 療 2. 狀 Primary PCI

46 PCI Percutaneous Coronary Intervention PTCA: Percutaneous Transluminal Coronary Angioplasty Devices: Balloon catheter, Stenting Laser, Atherectomy, ect

47 PCI Primary PCI: < 24hrs Rescue PCI: tpa Facilitated PCI: tpa + routine PCI Early PCI : < hrs Delay PCI: > 48-72hrs

48 狀 (CAG): After tpa therapy

49 狀 (PTCA)

50 狀

52 狀 ( Stent)

53 狀

54 Case 2 48-year year-old man was brought to ER because of severe chest pain with cold sweating 15 min ago Smoking 1 PPD for more 20 years Troponin I: 0.02, CK 81, CK-MB 5

55 Mr. Tsae,, 48-year year-old man, History No: , initial ECG at admission

56 CAG-case 2, before PCI

57 CAG-case 2, after PCI Troponin I 0.03, CK 168/68

58 Question of case 2 Did this patient have acute myocardial infarction?

59 塞 Early reperfusion therapies can prevent detectable myonecrosis Fibrinolysis < 1h : Aborted MI is seen in up to 25% of patients JACC 2004;44: 38-43

63 療 : EKG STEMI or New LBBB : 療. BP>180/110, 15mmHg CNS lesion (3 ) 6 GI/GU bleeding CPR>10min,, : 不 SBP<100, HR>100,,

64 Reperfusion 略 : onset of symptoms, Risk of STEMI, Risk of fibrinolysis : t-pa primary PCI PCI t-pa 列 PCI : No skilled PCI facility, no vascular assess 3. Door-to-balloon > 90 min 4. (D-B) - (D-needle) > 60 min

65 Time to PCI vs fibrinolysis in STEMI PCI better Fibrinolysis better Circulation 2006;114:

66 聆

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Microsoft Word - 14-4.V.z.....W.._...^.._.doc 308 台灣中醫臨床醫學雜誌 2008:14(4) 與中醫經脈循行相關的心肌梗塞臨床病案一則蔡德豐臺北市立聯合醫院忠孝院區中醫科摘要一位 41 歲男性 96 年 8 月因突發性胸痛至某醫學中心急診, 檢查發現為心肌梗塞, 經緊急施行冠狀動